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Business Analyst II

2 months ago

Tampa, Florida, United States Elevance Health Full time
About the Role

We are seeking a highly skilled Business Analyst II to join our team at Elevance Health. As a Business Analyst II, you will play a critical role in identifying, analyzing, and validating medical overpayments, and developing strategies to avoid future overpayments.

Key Responsibilities
  • Analyze business needs to determine optimal means of meeting those needs.
  • Act as liaison with users of the software to address questions/issues.
  • Research all resource documents and web-sites.
  • Document findings that support the concept.
  • Request and/or run queries as needed to retrieve data.
  • Meet with various business partners as needed.
  • Submit enhancement request for database updates.
  • Ensures proper review of the Forager Pipeline and Analyst reports.
  • Commit to deliverables and maintain timely turnaround times.
  • Determines specific business application software requirements to address specific business needs.
  • Works with programming staff to ensure requirements will be incorporated into system design and testing.
  • Perform data mining utilizing CPT, HCPCS, DRG, ICD-9, ICD-10, etc., to identify recovery opportunities.
  • Validate overpayments, complete Approach document and forward necessary files and documents for CCU Load.
Requirements
  • Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
  • Healthcare business analysis experience preferred.
  • Experience in using Facets, SQL and MACESS highly preferred.
  • Medical billing and/or claims processing experience is preferred.
  • 2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans strongly preferred.
  • Medical coding experience - CPT, HCPCS, ICD-9/10 coding preferred.
  • CPC or applicable professional designation preferred.
  • Proficient of Microsoft Office products, most notably expertise in Excel for reporting, Word, PowerPoint, Teams, and Outlook strongly preferred.
About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

What We Offer

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Work Environment

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

Equal Employment Opportunity

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.